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NPI Code Detail

MEDICARE: KIM MARIE MCKINNON NP

MEDICARE: KIM MARIE MCKINNON NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician294366-4405UT
2363LF0000XFamily Nurse Practitioner294366-8900UT
3363LP0808XPsychiatric/Mental Health Nurse Practitioner294366-8900UT

General Provider Information

NPI Number : 1003302548
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIM MARIE MCKINNON NP
Provider Business Mailing Address
First Line : 8197 S 5140 W
Second Line :
City : WEST JORDAN
State : UT
Zip : 84081-2705
Country : US
Telephone Number : 801-895-6171
Fax Number :
Provider Business Practice Location Address
First Line : 45 W SEGO LILY DR STE 312
Second Line :
City : SANDY
State : UT
Zip : 84070-3643
Country : US
Telephone Number : 801-676-9452
Fax Number : 801-206-9734
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2018
Last Update Date : 01/13/2021

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